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Masuda T, Hata M, Yamaya K, Suzuki T, Terao N. Two Cases of Endovascular Repair with the Stent Graft for Retrograde Type A Acute Aortic Dissection with Complications. Ann Thorac Cardiovasc Surg 2019; 25:278-282. [PMID: 29503377 PMCID: PMC6823173 DOI: 10.5761/atcs.cr.17-00200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) is used to treat retrograde type A acute aortic dissection (RTAAD). In case 1, a 52-year-old man, who was conservatively managed, reported worsening back pain. Emergency TEVAR was performed 7 days after onset. After deploying two GORE Conformable TAG (CTAG) in the descending aorta, his symptoms disappeared. In case 2, a 52-year-old man with progressive worsening resistant hypertension, renal dysfunction, and respiratory failure despite maximal medical therapy underwent TEVAR 8 days after onset. A CTAG was deployed from the left subclavian artery under rapid pacing, and two Zenith Dissection stents were placed, which resolved complications. In both cases, after 6 months, computed tomography (CT) scan showed complete resorption of the false lumen in the ascending aorta. TEVAR for RTAAD with complete thrombosis of false lumen in the ascending aorta can be an alternative to surgery when the primary tear is located in descending aorta.
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Affiliation(s)
- Takahiko Masuda
- Department of Cardiovascular Surgery, Sendai Kosei Hospital, Sendai, Miyagi, Japan
| | - Masaki Hata
- Department of Cardiovascular Surgery, Sendai Kosei Hospital, Sendai, Miyagi, Japan
| | - Kazuhiro Yamaya
- Department of Cardiovascular Surgery, Sendai Kosei Hospital, Sendai, Miyagi, Japan
| | - Tomoyuki Suzuki
- Department of Cardiovascular Surgery, Sendai Kosei Hospital, Sendai, Miyagi, Japan
| | - Naoya Terao
- Department of Cardiovascular Surgery, Sendai Kosei Hospital, Sendai, Miyagi, Japan
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MacKnight BM, Maldonado Y, Augoustides JG, Cardenas RA, Patel PA, Ghadimi K, Gutsche JT, Ramakrishna H. Advances in Imaging for the Management of Acute Aortic Syndromes: Focus on Transesophageal Echocardiography and Type-A Aortic Dissection for the Perioperative Echocardiographer. J Cardiothorac Vasc Anesth 2016; 30:1129-41. [DOI: 10.1053/j.jvca.2016.01.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Indexed: 01/16/2023]
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Follis F, Raffa GM, D'Ancona G, Amaducci A, Follis M. Stanford Type A Acute Retrograde Aortic Dissections: From Surgical to Endovascular Strategy? Artif Organs 2015; 40:394-7. [DOI: 10.1111/aor.12562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Fabrizio Follis
- Cardiac Surgery and Heart Transplantation Unit; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione); Palermo Italy
| | - Giuseppe M. Raffa
- Cardiac Surgery and Heart Transplantation Unit; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione); Palermo Italy
| | - Giuseppe D'Ancona
- Cardiac Surgery and Heart Transplantation Unit; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione); Palermo Italy
| | - Andrea Amaducci
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione); Palermo Italy
| | - Marco Follis
- Department of Cardiac Surgery; Albert Einstein College of Medicine; New York NY USA
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Chen SL, Zhu JC, Li XB, Ye F, Zhang JJ, Liu ZZ, Tian NL, Lin S, Lv CY. Comparison of long-term clinical outcome between patients with chronic versus acute type B aortic dissection treated by implantation of a stent graft: a single-center report. Patient Prefer Adherence 2013; 7:319-27. [PMID: 23637523 PMCID: PMC3635660 DOI: 10.2147/ppa.s39012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Stent grafting for treatment of type B aortic dissection has been extensively used. However, the difference in the long-term clinical outcome between patients with chronic versus acute type B aortic dissection remains unknown. This study aimed to analyze the difference in long-term clinical outcome after endovascular repair for patients with chronic (≥2 weeks) versus acute (<2 weeks) type B aortic dissection. METHODS Between May 2000 and June 2011, a total of 174 patients with type B aortic dissection (56 chronic, 118 acute) treated by endovascular repair were studied prospectively. Follow-up three-dimensional computed tomography scanning and aortoangiography were scheduled at 3-6 months after the index procedure. Propensity score matching was used to compare the difference in the endpoint between the two groups. RESULTS The procedure-related event rate was 18.6% in the acute group and 5.4% in the chronic group (P = 0.021), but this difference became nonsignificant after propensity score matching. At the end of follow-up (mean 2.49 years), overall and aorta-related mortality was 11.0% and 7.6%, respectively, in the acute group, and was not significantly different from that in the chronic group (3.6% and 3.6%, P = 0.148 and P = 0.506, respectively). Both false and true lumina showed significant remodeling over time, with >93% complete false-lumen thrombosis. Untreated tear and type I endoleak were predictors of clinical events during follow-up. CONCLUSION Comparable long-term clinical results were achieved in patients with chronic or acute type B aortic dissection after implantation of a stent graft.
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Affiliation(s)
- Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Jian-Cheng Zhu
- Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Xiao-Bo Li
- Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Fei Ye
- Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Jun-Jie Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Zhi-Zhong Liu
- Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Nai-Liang Tian
- Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Song Lin
- Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Cheng-Yu Lv
- Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
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Lyons O, Clough R, Patel A, Saha P, Carrell T, Taylor P. Endovascular Management of Stanford Type A Dissection or Intramural Hematoma With a Distal Primary Entry Tear. J Endovasc Ther 2011; 18:591-600. [DOI: 10.1583/11-3468.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Rousseau H, Cosin O, Marcheix B, Chabbert V, Midulla M, Dambrin C, Cron C, Leobon B, Conil C, Massabuau P, Otal P, Joffre F. Endovascular treatment of thoracic dissection. Semin Intervent Radiol 2011; 24:167-79. [PMID: 21326794 DOI: 10.1055/s-2007-980041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Type A aortic dissection remains fatal if untreated. Although classical medical therapy for type B dissection is considered the therapy of choice in uncomplicated cases, the paradigm is changing as greater experience is accrued with endovascular treatments and technical advances improve the long-term outlook. Diagnosis is also becoming more sophisticated, allowing greater appreciation of the anatomy of dissections and improving the knowledge base as their natural history is assessed.
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Affiliation(s)
- H Rousseau
- Department of Radiology, Cardio-Vascular Surgery and Cardiology, Hôpital Rangueil, Toulouse, France
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Ong SH, Mueller R, Gerckens U. Iatrogenic dissection of the ascending aorta during TAVI sealed with the corevalve revalving prosthesis. Catheter Cardiovasc Interv 2011; 77:910-4. [DOI: 10.1002/ccd.22900] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 10/27/2010] [Indexed: 11/05/2022]
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Jiang J, Ding X, Zhang G, Hu S, Su Q, Li F. Endovascular Stent-graft Placement for Retrograde Type A Aortic Dissection. J Vasc Interv Radiol 2011; 22:415-7. [DOI: 10.1016/j.jvir.2010.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 10/27/2010] [Accepted: 11/14/2010] [Indexed: 10/18/2022] Open
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Affiliation(s)
- Warren Swee
- From the Department of Radiology, Division of Angiography and Interventional Radiology, University of Virginia Health System, Charlottesville, Va
| | - Michael D. Dake
- From the Department of Radiology, Division of Angiography and Interventional Radiology, University of Virginia Health System, Charlottesville, Va
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Karmy-Jones R, Simeone A, Meissner M, Granvall B, Nicholls S. Descending thoracic aortic dissections. Surg Clin North Am 2007; 87:1047-86, viii-ix. [PMID: 17936475 DOI: 10.1016/j.suc.2007.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Type B dissection has traditionally been managed medically if uncomplicated and surgically if associated with complications. This practice has resulted in most centers reporting significant morbidity and mortality if open repair is required. In the setting of malperfusion, operative repair has been conjoined with fenestration or visceral stenting to improve outcomes. Endovascular stent grafts seem to offer an attractive alternative in the acute complicated type B dissection, with reduced mortality and morbidity, particularly paralysis, compared with open repair. It is reasonable to consider endovascular stent grafts as another tool in managing dissection, but to recognize that open surgical repair still plays an important role, and that the data that define indications and outcomes are still emerging.
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Affiliation(s)
- Riyad Karmy-Jones
- Division of Thoracic Surgery, Heart and Vascular Institute, Southwest Washington Medical Center, P.O. Box 1600 Vancouver, WA 98668, USA.
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Breda JR, Breda ASR, Fujii EY, Corrêa JA, Meneghini A, Jaramilo JI, Almeida DRD, Pires AC. Tratamento endovascular de ruptura traumática da aorta torácica descendente. J Vasc Bras 2007. [DOI: 10.1590/s1677-54492007000200013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Paciente do sexo feminino, 55 anos de idade, vítima de atropelamento, foi admitida em unidade de emergência, onde se realizou o diagnóstico clínico, radiológico e tomográfico de ruptura traumática da aorta torácica descendente. Diante do achado, a paciente foi encaminhada para tratamento endovascular com colocação de endoprótese auto-expansível (stent) pela artéria femoral. O tratamento obteve sucesso, evidenciado pela exclusão da lesão localizada previamente no istmo aórtico. O tratamento endovascular tem sido indicado nas afecções de aorta torácica descendente com bons resultados iniciais. Na ruptura traumática de aorta, a terapêutica endovascular representa uma alternativa aceitável, especialmente devido aos riscos do tratamento operatório convencional.
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Abstract
Endovascular stent grafts are now accepted globally and approved by the US Food and Drug Administration as an alternative to open surgical repair for patients with descending thoracic aortic aneurysm. However, as opposed to the abdominal aorta, application of this technology to manage thoracic aortic disease is not limited to degenerative aneurysms. In fact, international registries and surveys estimate that only 60% of the thoracic cases managed currently with stent-graft placement are aneurysms. The remainder of this experience includes acute dissection, chronic dissection, traumatic aortic injury, penetrating ulcer, intramural hematoma, aortic fistula, anastomotic pseudoaneurysm, and an embolizing lesion. In this regard, it is important to keep in mind that the present devices used in these nonaneurysmal applications are not designed to address the unique anatomical and pathological features that these lesions present. Consequently, in the future, it is possible that we will see stent-graft designs that focus specifically on the challenges of some of the nonaneurysmal thoracic aortic pathologies.
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Affiliation(s)
- Michael D Dake
- Department of Radiology, University of Virginia Health System, Charlottesville, VA 22908-0170, USA
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Chen S, Yei F, Zhou L, Luo J, Zhang J, Shan S, Tian N, Kwan TW. Endovascular stent-grafts treatment in acute aortic dissection (type B): Clinical outcomes during early, late, or chronic phases. Catheter Cardiovasc Interv 2006; 68:319-25. [PMID: 16821238 DOI: 10.1002/ccd.20821] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This is a prospective study to evaluate the clinical outcomes of endovascular repair in patients with different phases of type B aortic dissection. BACKGROUND Endovascular repairing with stent-grafts is an innovative technique for type B acute aortic dissection. There is no previous study regarding outcomes in different time phases. METHODS Sixty-two patients underwent endovascular stent-grafts. There were 23 in the early phase (<24 hr), 20 in the late phase (>or=24 hr to 2 weeks), and 19 in the chronic phase (>2 weeks). RESULTS The early phase group had the lowest ratio of stent-grafts to patient and the shortest stent-graft length. The chronic phase group had the largest diameter of false lumen. The technical success rate was 100%; no patient died within hospital. Three patients died within 30 days, with the same death rate in every group. Compared with acute patients, the chronic group had a higher volume of contrast, a higher creatinine post-procedure, and a higher incidence of contrast-induced nephropathy. Multiple regression analysis demonstrated that creatinine and endoleak were independent factors in predicting late death (95% CI, 3.4-26%, P < 0.01). The overall cardiovascular event-free survival was 88.9% +/- 2.1% at 30 days, 87.2% +/- 4.1% at 1 year, and 81.4% +/- 6.3% at 2 years. CT angiography identified the complete or partial thrombosis of the false lumen to be 95.7%. CONCLUSIONS Endovascular repairing with stent-graft is safe, feasible, and able to treat type B aortic dissection in all phases. However, chronic renal dysfunction was an independent factor which contributed to a lower survival rate of chronic phase patients.
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Affiliation(s)
- Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital of Nanjing Medical University, Nanjing, China.
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Kusagawa H, Shimono T, Ishida M, Suzuki T, Yasuda F, Yuasa U, Onoda K, Yada I, Hirano T, Takeda K, Kato N. Changes in False Lumen After Transluminal Stent-Graft Placement in Aortic Dissections. Circulation 2005; 111:2951-7. [PMID: 15927978 DOI: 10.1161/circulationaha.104.480780] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Transluminal stent-graft placements (TSGPs) are a new, less invasive procedure now recognized as the choice for aortic disease repair. Treatment of aortic dissections with TSGPs has resulted in good early results, but the long-term results and changes in the false lumen have not been elucidated in detail.
Methods and Results—
TSGPs were performed in 49 patients with primary tears in their descending aortas, and the follow-up period ranged from 4 months to 6 years. The patients were divided into 32 acute-onset and 17 chronic dissections; of the acute-onset cases, there were 15 Stanford type A retrograde dissections. Periodic enhanced spiral CT was conducted after TSGP. The false lumen in the ascending aorta in 14 (93%) of the Stanford type A cases was obliterated completely within 3 months. The CT study was continued for >2 years for 17 acute-onset dissection and 11 chronic dissection patients. The average false lumen diameters of the proximal, middle, and distal descending aorta before treatment were 15.9, 16.2, and 15.6 mm in the acute-onset dissection group and 28.1, 25.2, and 21.0 mm in the chronic dissection group, respectively. The false lumen diameters 2 years after treatment were 3.0, 3.7, and 3.1 mm in the acute-onset dissection group and 10.6, 10.5, and 11.9 mm in the chronic dissection group, respectively. Two years after TSGPs, the false lumen of the thoracic aorta totally disappeared in 76% of the acute-onset dissection group and 36% of the chronic dissection group. No cases showed rupture after TSGP.
Conclusions—
Complete obliteration of the false lumen is more likely in acute-onset cases than in chronic cases.
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Affiliation(s)
- Hitoshi Kusagawa
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Mie, Japan
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Tratamiento endovascular inmediato con stent-graft en laceración traumática de aorta torácica. Med Intensiva 2003. [DOI: 10.1016/s0210-5691(03)79940-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The treatment of thoracic aortic pathology is complicated by the morbidity of the surgical procedure, and the comorbidities encountered in an elderly population. Stent grafts have now been used for approximately 10 years for the treatment of thoracic aneurysmal disease, management of aortic dissections, intramural hematoma, and giant penetrating ulcers, and for traumatic aortic tears, with impressive early results. However, these efforts have been significantly limited by the lack of a commercially available stent graft specifically designed for the thoracic aorta, the lack of real long-term follow-up, and the failure of experience in the abdominal aorta to translate to the thoracic aorta. Nevertheless, significant and even unique therapies have been enabled by stent graft technology for the treatment of the above-mentioned diseases. It is likely that, with more sophisticated technology and improved understanding of thoracic aortic pathology, stent graft use will expand, and its utility will be further clarified.
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Affiliation(s)
- R Scott Mitchell
- Department of Cardiovascular and Thoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, California 94305-5247, USA.
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Kato N, Shimono T, Hirano T, Suzuki T, Ishida M, Sakuma H, Yada I, Takeda K. Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear: the complication-specific approach. J Thorac Cardiovasc Surg 2002; 124:306-12. [PMID: 12167791 DOI: 10.1067/mtc.2002.122302] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Endovascular stent-graft placement for the treatment of patients with aortic dissection is emerging as an attractive alternative to conventional cardiac operations. However, there has been no report of longer-term follow-up. The purpose of this study is to describe our midterm results with endovascular stent-graft repair for the treatment of patients with aortic dissections. METHODS Thirty-eight patients with aortic dissections with descending tears were treated with endovascular stent-grafting. Ten patients had acute type A, 14 patients had acute type B, and 14 patients had chronic type B dissection. Stent grafts fabricated from expanded polytetrafluoroethylene-covered Z stents were placed to close entry tears in all patients through the delivery systems introduced from the femoral or the iliac arteries. RESULTS Two patients with complicated acute type B dissection, who would have required surgical intervention, died within 30 days of the procedure, although no other patients died within the same period. There were no late deaths during the mean follow-up period of 27 months. Early and late complication rates were 33% and 36%, respectively, in patients with acute dissection, whereas rates were 4% and 0% (P <.05 vs patients with acute dissection) in patients with chronic dissection. CONCLUSIONS Entry closure with endovascular stent-graft placement may be a safe and effective method for the treatment of patients with aortic dissection. It could be an alternative to conventional surgical intervention in selected patients with chronic dissection. However, strict patient selection and close follow-up seem mandatory in patients with acute dissection receiving Z stent-based stent-grafts. Stent-graft repair should be delayed for acute type B dissection without complications.
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Affiliation(s)
- Noriyuki Kato
- Department of Radiology Mie University Hospital, 2-1784 Edobashi, Tsu, Mie 514, Japan.
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Suzuki T, Shimono T, Kato N, Yuasa U, Onoda K, Hirano T, Takada K, Yada I. Extended total arch replacement by means of the open stent-grafting method to treat intimal tears after transluminal stent-graft placement for a ruptured acute type B aortic dissection. J Thorac Cardiovasc Surg 2002; 123:354-6. [PMID: 11828299 DOI: 10.1067/mtc.2002.117533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tomoaki Suzuki
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan
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Kato N, Hirano T, Shimono T, Ishida M, Takano K, Nishide Y, Kawaguchi T, Yada I, Takeda K. Treatment of chronic aortic dissection by transluminal endovascular stent-graft placement: preliminary results. J Vasc Interv Radiol 2001; 12:835-40. [PMID: 11435539 DOI: 10.1016/s1051-0443(07)61508-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate efficacy of stent-graft repair for the treatment of patients with chronic aortic dissection. MATERIALS AND METHODS Fifteen patients with chronic aortic dissection were treated with endovascular stent-grafts. Entry tears were located in the descending thoracic aorta in all patients. The mean maximum diameter of the descending thoracic aorta was 47 mm +/- 8. The mean diameter of the true lumen at the same level was 20 mm +/- 5. The mean interval between diagnosis and stent-graft procedure was 32 months +/- 91. Stent-grafts were fabricated from expanded polytetrafluoroethylene and Z-stents. RESULTS Stent-grafts were placed successfully in all patients. Two stent-grafts were required in one patient. Entry closure and thrombosis of the false lumen of the descending thoracic aorta were also achieved in all patients. No procedure-related complications were observed except for postimplantation syndrome, including fever and leukocytosis. The diameter of the true lumen was significantly increased (mean, 31 mm +/- 6) at the level of the descending thoracic aorta (P <.01) and the diameter of the aorta was significantly decreased (mean, 44 mm +/- 8) at the same level (P <.01). There were no deaths and no instances of aortic rupture during the subsequent average follow-up period of 24 months. Secondary stent-graft procedures were required to treat the abdominal component of dissection during follow-up in one patient. CONCLUSIONS Stent-graft repair of chronic aortic dissection is a safe and effective method and may be an alternative to surgical graft replacement in selected patients. However, further evaluation is mandatory before this method is widely employed.
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Affiliation(s)
- N Kato
- Department of Radiology, Mie University Hospital, Tsu, Japan.
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Dorros G, Dorros AM, Planton S, O'Hair D, Zayed M. Transseptal guidewire stabilization facilitates stent-graft deployment for persistent proximal ascending aortic dissection. J Endovasc Ther 2000; 7:506-12. [PMID: 11194823 DOI: 10.1177/152660280000700612] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report endovascular repair of a DeBakey type I ascending aortic dissection. CASE REPORT Five months after aortocoronary bypass grafting, a 56-year-old woman demonstrated a persistent ascending aortic type I dissection whose entry tear proximal to the innominate artery spiraled down the descending thoracic aorta into the iliofemoral arteries. Repair was facilitated with a guidewire passed through a transseptal sheath in the right femoral vein. The guidewire traversed the right and left atria and the left ventricle and then exited into the ascending aorta and was exteriorized through the right femoral artery. A right brachial catheter aided contrast visualization of the innominate artery. Adenosine-induced elective cardiac arrest promoted precise placement of a customized polyester-covered balloon-expandable stent, which closed the aortic rent. CONCLUSIONS A transseptal approach enables the guidewire to follow the curvature of the aortic arch, providing precise control of the stent-graft delivery system. This case illustrates the applicability of endovascular techniques to repair ascending aortic pathologies using readily available techniques, equipment, and drugs.
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Affiliation(s)
- G Dorros
- The William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation and St. Luke's Medical Center, Milwaukee, Wisconsin, USA.
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Dorros G, Dorros AM, Planton S, O'Hair D, Zayed M. Transseptal Guidewire Stabilization Facilitates Stent-Graft Deployment for Persistent Proximal Ascending Aortic Dissection. J Endovasc Ther 2000. [DOI: 10.1583/1545-1550(2000)007<0506:tgsfsg>2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tokui T, Shimono T, Kato N, Hirano T, Takeda K, Yada I. Less invasive therapy using endovascular stent graft repair and video-assisted thoracoscopic surgery for ruptured acute aortic dissection. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2000; 48:603-6. [PMID: 11030137 DOI: 10.1007/bf03218211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a 75-year-old man with a ruptured acute thoracic aortic dissecting hematoma treated using endovascular stent grafting and video-assisted thoracoscopic surgery. This less invasive therapy is a good therapeutic option even in ruptured acute aortic dissections, particularly given the difficulty of surgery.
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Affiliation(s)
- T Tokui
- Department of Thoracic and Cardiovascular Surgery, Mie University, School of Medicine, Tsu, Japan
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